HomeMy WebLinkAbout09-27-06
REV-l500 EX + (&-00)
COMMONWEALTH OF
PENNSYLVANIA
DEPARTMENT OF REVENUE
DEPT. 280601
HARRISBURG, PA 17128-0601
REV -1500
INHERITANCE TAX RETURN
RESIDENT DECEDENT
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DECF.DENrS NAME (LAST, FIRST, AND MIDDLE INITIAL)
04/29/2006 01/23/1924
(IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL}
001. Original Return
o 4. Limited Estate
00 6. DecedentDied Testate (AIlach copyotWiII)
o 9. Litigation Proceeds Received
o 2. Supplemental Return
o 4a. Future Interest Compromise (datBotdeath after 12-12-82)
o 7. Decedent Maintained a Living Trust (AlIach copy of Trust)
o 10. Spousal Poverty Credit (dale of death belween 12-31-91 and 1-1-95)
OFFICIAL USE ONLY
FilE NUMBER
2 1 -0 6 0 4 0 0
COUNTYCOOE -YEAR- - - NuMBER- -
SOCIAL SECURITY NUMBER
1 92- 1 4 - 5 089
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
SOCIAL SECURITY NUMBER
o 3. Remainder Return (daleofdealhprior1D12-13-82)
o 5. Federal Estate Tax Retum Required
Q... 8. Total Number of Safe Deposit Boxes
D 11. Election to tax under Sec. 9113(A) (AIlach Sch 0)
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COMPLETE MAILING ADDRESS
14 North Main Street, Suite 200
NAME
Joel R. Zullin er
FIRM NAME (If Applicable)
Zullin er Davis P.C.
TELEPHONE NUMBER
717264-6029
Chambersbur
PA 17201
161 ,352.93
183.252.86
) ..-
OFFICIAL USE ONLY
(1)
(2)
(3)
(4)
(5)
1. Real Estate (Schedule A)
2. Stocks and Bonds (Schedule B)
3. Closely Held Corporation. Partnership or Sole-Proprietorship
4. Mortgages & Notes Receivable (Schedule D)
5. Cash, Bank Deposits & Miscellaneous Personal Property
(Schedule E)
6. Jointly Owned Property (Schedule F)
o Separate Billing Requested
7. Inter-Vivos Transfers & Miscellaneous Non.Probate Property
(Schedule G or L)
8. Total Gross Assets (total Lines 1-7)
9. Funeral Expenses & Administrative Costs (Schedule H)
10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I)
11. Total Deductions (total Lines 9 & 10)
12. Net Value of Estate (Line 8 minus Line 11)
13. Charitable and Governmental Bequests/See 9113 Trusts for which an election to tax has not been
made (Schedule J)
(6)
(7)
(9)
(10)
14. Net Value Subject to Tax (Line 12 minus Line 13)
SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES
15. Amount of Line 14 taxable at the spousal tax
rate, or transfers under Sec. 9116 (a)(1.2)
0.00 X _ (15)
433,484.28 X .045 (16)
0.00 X .12 (17)
0.00 X .15 (18)
(19)
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16. Amount of Line 14 taxable at lineal rate
17. Amount of Line 14 taxable at sibling rate
18. Amount of Line 14 taxable at collateral rate
19. Tax Due
20. 0
CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAyr.1ENT
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46,14233 ~ .)~ _~:
103.276.51 ,~~ .
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(8)
494.024.63
50,408.74
131.61
(11)
(12)
(13)
50.540.35
443,484.28
10.000.00
(14)
433,484.28
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ece en s ompl e e ress:
STREET ADDRESS
. 1'115 Newburg Road
CITY I STATE I ZIP
Shippensburg PA 17257
Tax Payments and Credits:
1. Tax Due (Page 1 Une 19)
2. Credits/Payments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
(1)
19,506.79
17.527.50
922.50
Total Credits (A + B + C)
(2)
18,450.00
3. InteresUPenalty if applicable
D. Interest
E. Penalty
TotallnteresUPenalty ( D + E) (3)
4. If Line 2 is greater than Une 1 + Line 3, enter the difference. This is the OVERPAYMENT.
Check box on Page 1 Line 20 to request a refund (4)
5. If Line 1 + Une 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5)
A. Enter the interest on the tax due. (SA)
B. Enter the total of Line 5 + SA. This is the BALANCE DUE. (58)
Make Check Payable to: REGISTER OF WILLS, AGENT
PLEASE ANSWER THE FOllOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS
1. Did decedent make a transfer and: Yes No
a. retain the use or income ofthe property transferred; ........................................................................... 0 00
b. retain the right to designate who shall use the property transferred or its income; ........................................ 0 00
c. retain a reversionary interest; or ...................................................................................................... 0 00
d. receive the promise for life of either payments, benefits or care? ........ ..................... ........... ..................... 0 00
2. If death occurred after December 12, 1982, did decedent transfer property within one year of death
without receiving adequate consideration?....... ............ ........... .............. .................. ..... ............................ 0 00
3. Did decedent own an "in trust for' or payable upon death bank account or security at his or her death? ................. 0 00
4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which
contains a beneficiary designation? ..... ........ .......... ......... ..... ........ ............ ......:.... ......... .............. ............ 00 0
0.00
0.00
1,056.79
1,056.79
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
Under penaties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct and complete.
Declaration of preparer other than the personal representative is based on all infonnatioo of Which preparer has any knowledge.
S A TU E OF PERSON RESPONSIBL FOR FILING RETURN DATE
PA 17257
DATE
PA 17201
For dates of death on or atter July 1, 1994 and before January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 3%
[72 P.S. ~9116 (a) (1.1) (i)].
For dates of death on or after January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0% [72 P.S. ~9116 (a) (1.1) (ii)].
The statute does not exemot a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and filing a tax return are still applicable even if
the surviving spouse is the only beneficiary.
For dates of death on or after July 1, 2000:
The tax rate imposed on the net value of transfers from a deceased child twenty-one years of age or younger at death to or for the use of a natural parent, an adoptive parent,
or a stepparent of the child is 0% [72 P.S. ~9116(a)(1.2)].
The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is 4.5%, except as noted in 72 P.S. ~9116(1.2) [72 P.S. ~9116(a)(1)].
The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12% [72 P.S. ~9116(a)(1.3)]. A sibling is defined, under Section 9102, as an
individual who has at least one parent in common with the decedent, whether by blood or adoption.
REV-1502 EX + (6-9B)
.
SCHEDULE A
REAL eST A 1E
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Gavman MarQaret Marie a/kla Gayman MarQaret M 21 06 0400
All real property owned solely or as a tenant in common must be reported at fair market value. Fair ma~et value is defined as the price at which property would be
exchanged between a willing buyer and a willing seller, neither being compelled to buy or sell, both having reasonable knowledge of the relevant facts.
Real property which is iointlv-owned with riaht of sUlVivorshiD must be disclosed on Schedule F.
ITEM
NUMBER
1.
DESCRIPTION
Gross proceeds from sale of real estate at 1115 Newburg
Road, Shippensburg, PA, to Harold linn Gayman and
Olivia J .linn
Received on proration of real estate taxes at sale of
above real estate
2.
VALUE AT DATE
OF DEATH
160,000.00
1,352.93
TOT At (Also enter on line 1, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
161 352.93
REV-1503 EX + (6-98)
'*
SCHEDULE B
STOCKS & BONDS
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Gavman MarQaret Marie a1k1a Gavman. Margaret M 21 06 0400
All property jointly-owned with right of survivorship must be disclosed on Schedule F.
ITEM
NUMBER
1.
DESCRIPTION
Account #6390344619308, Smith Barney consisting
of the following assets as shown on attached
valuation:
Cash
Bank Deposit Program, including accrued interest
3049.8696 shares Municipal High Income Fund
Inc. @7.37 per share
1247.122 shares Capital World Growth & Income
Fund Class C @40.08 per share
4166.593 shares Legg Mason Partners Capital
& Income Fund Class A @17.71 per share
25,000 Lehman Brothers Bank, FSB, including
interest accrued to date of death
10,000 Rabobank Natn'l Assn. California,
including interest accrued to date of death
VALUE AT DATE
OF DEATH
42.47
1,795.51
22,477.54
49,984.65
73,790.37
25,126.71
10,035.61
TOTAL (Also enter on line 2, Recapitulation) $
(If more space is needed. insert additional sheets of the same size)
183252.86
REV-1508 EX + (6-98)
.
SCHEDULE E
CASH, BANK OEPOSITS, & MISC.
PERSONAL PROPERTY
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Gayman MarQaret Marie a/kJa Gavman MarQaret M 21 06
Include the proceeds of litigation and the date the proceeds were received by the estate.
All property jointly-owned with right of survivorship must be disclosed on Schedule F.
0400
ITEM
NUMBER
1.
2.
3.
4.
5.
6.
7.
DESCRIPTION
Checking Account #67354629, M& T Bank,
including interest accrued to date of death
2000 Mercury Sable GS Sedan
Distribution from the Estate of Virginia S. Walker
Net proceeds sale of personal property by Matt S.
Hurley, Auctioneer
Refund, Waste Management
Refund, Comcast Cable
Refund, Nationwide Insurance
VALUE AT DATE
OF DEATH
12,831.57
4,800.00
9,093.29
19,003.33
27.09
39.05
348.00
TOTAL (Also enter on line 5, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
46 142.33
REV-1510 EX + (6-98)
.
SCHEDULE G
INTER-VIVOS TRANSFERS &
MISC. NON-PROBATE PROPERTY
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Gavman Margaret Marie. a1k1a Gavman. Margaret M.
FILE NUMBER
21 06
0400
This schedule must be completed and filed if the answer to any of questions 1 through 4 on the reverse side of the REV-1500 COVER SHEET is yes.
DESCRIPTION OF PROPERTY
ITEM INClUDE THE NAME OF THE TRANSFEREE, THEIR RElATIONSHIP TO OECEDENT AND DATE OF DEATH % OF DECO'S EXCLUSION TAXABLE
NUMBER THE DATE OF TRANSFER. ATTACH A COPY OF THE DEED FOR REAl. ESTATE. VALUE OF ASSeT INTEREST VALUE
OF APPUCABlE)
1. Annuity Acct. #01 OSP730424, Monumental Life Insurance
Company, beneficiaries are children of decedent-Harold L.
Gayman 25%; Leslie S. Gayman 25%; Rosalyn M. Kann
25%; Glenda K. Craig 25% 67,594.86 100. 67,594.86
2. Annuity Acct. #AN202303, AIG Annuity Insurance Company,
beneficiaries are children of decedent-Harold L. Gayman 25%
Leslie S. Gayman 25%; Rosalyn Kann 25%; Glenda
Craig 25% 35,681.65 100. 35,681.65
TOTAL (Also enter on line 7 Recapitulation) $ 103276.51
(If more space is needed, insert additional sheets of the same size)
REV-1511 EX + (12-99)
'*
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
SCHEDULE H
FUNERAL exPENSES &
ADMINISTRATIVE COSTS
FILE NUMBER
Gavman MarQaret Marie alkla Gavman MarQaret M
Debts of decedent must be reported on Schedule I.
ITEM
NUMBER
A.
1.
2.
3.
B.
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
16.
17.
18.
21
06
DESCRIPTION
FUNERAL EXPENSES:
Fogelsanger-Bricker Funeral Home, funeral services
Meal after funeral service
Grave opening
ADMINISTRATIVE COSTS:
Personal Representative's Commissions
Name of Personal Representative (s) Leslie S. Gayman/Harold L. Gayman (50% to each)
Social Security Number(s}/EIN Number of Personal Representative(s)
StreetAddress 8634 NewburQ Rd., NewburQ, PA 17240 (Leslie)
City 199 Thorny Grove Lane, ShippensburQ State PA Zip 17257
Year(s) Commission Paid:
Attomey Fees Joel R. Zullinger
Family Exemption: (If decedents address is not the same as claimants, attach explanation)
Claimant
Street Address
City
Relationship of Claimant to Decedent
State
Zip
Probate Fees Register of Wills - Letters 410.00; will 15.00; short certificates 20.00;
JCP fee 10.00; automation fee 5.00; filing return 30.00
Accountants Fees
Tax Return Prepare~s Fees
Mowing grass at decedent's residence
Embarq, telephone service at decedent's residence
Cumberland Franklin Joint Municipal Authority, sewer service
Penelec, utilities at decedent's residence
Mowing grass at decedent's residence
Penelec, utilities at decedent's residence
Tim L. Ausherman, appraisal of real estate
Fee for estate checks
News-Chronicle, advertise letters
Cumberland Law Journal, advertise letters
Notary fee on deed for sale of real estate
Realty Transfer Tax on sale of real estate
TOTAL (Also enter on line 9, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
0400
AMOUNT
8,802.00
395.16
475.00
14,900.00
14,900.00
0.00
490.00
150.00
14.32
26.00
40.99
240.00
54.03
275.00
16.75
125.75
75.00
5.00
1,600.00
50408.74
Continuation of REV-1500 Inheritance Tax Return Resident Decedent
Gayman, Margaret Marie, alkJa Gayman, Margaret M.
Decedent's Name
Page 1
21 06 0400
File Number
Schedule H - Funeral Expenses & Administrative Costs - 87.
ITEM
NUMBER
DESCRIPTION
AMOUNT
19.
20.
21.
22.
23.
Vivian Coy, Tax Collector, 2006 school real estate tax paid at sale of real estate
Legacy Auction, commission on sale of real estate
Penelec, final utility bill for decedent's residence
C.F.J.M.A., final sewer bill for decedent's residence
Martin's Refrigeration, service of air conditioning at residence prior to sale
1,314.48
6,345.74
23.52
26.00
114.00
SUBTOTAL SCHEDULE H.B7
7,823.74
REV-1512 EX + (6-98)
*
SCHEDULE.
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES & LIENS
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Gavman Maraaret Marie alkla Gayman Maraaret M.
Include unreimbursed medical expenses.
FILE NUMBER
21 06
0400
ITEM
NUMBER DESCRIPTION
1. Joel H. McGahen, medical services
VALUE AT DATE
OF DEATH
15.00
2. Cumberland Franklin Joint Municipal Authority, sewer service due at death
27.30
3. Sprint, telephone service due at death
11.03
4. Chambersburg Hospital, medical services
78.28
TOTAL (Also enter on fine 10, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
131.61
REV""'.EX"",
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
SCHEDULE J
BENEFICIARIES
FILE NUMBER
u......... a/k/a - . M. 21 06 0400
RELATIONSHIP TO DECEDENT AMOUNT OR SHARE
NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE
I. TAXABLE DISTRIBUTIONS pnclude outright spousal distributions, and transfers under
Sec. 9116 (a) (1.2)}
1. Ryan Gayman Lineal 4,800.00
8634 Newburg Road car at appraised value
Newburg, PA 17240
2. Glenda Kay Craig 25% of Item 1, Sch. G - 16,898.72 Lineal 107,171.07
2850 Orrstown Road 25% of Item 2, Sch. G - 8,920.41
Shippensburg, PA 17257 1/4 of residue - 81,351.94
3. Rosalyn Marie Kann 25% of Item 1, Sch. G -16,898.72 Lineal 107,171.07
3522 Eden Place 25% of Item 2, Sch. G - 8,920.41
Carmel, IN 46032 1/4 of residue - 81,351.94
4. Leslie S. Gayman 25% of Item 1, Sch. G - 16,898.71 Lineal 107,171.07
8634 Newburg Road 25% of Item 2, Sch. G - 8,920.41
Newburg, PA 17240 1/4 of residue - 81,351.95
5. Harold L. Gayman 25% of Item 1, Sch. G -16,898.71 Lineal 107,171.07
199 Thorny Grove Lane 25% of Item 2, Sch. G - 8,920.42
Shippensburg, PA 17257 1/4 of residue - 81,351.94
Lineal
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE, ON REV-1500 COVER SHEET
n. NON-TAXABLE DISTRIBUTIONS:
A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE
1. 0.00
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
1. Saint Judes Children's Hospital of Memphis, Tennessee 10,000.00
332 N. Lauderdale Street
Memphis, TN 38105
TOTAL OF PART 11- ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET $ 10000.00
(If more space is needed, insert additional sheets of the same size)
LAST WILL AND TESTAfv1ENT
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KNOW ALL MEN BY THESE PRESENTS, that I, MARGARET M. GAYMAN, of
Pennsylvania, being of sound and disposing mind, memory and understanding, do
make, publish and declare this my Last Will and Testament, hereby revoking all prior
wills and codicils by me at any time heretofore made.
FIRST: I direct the payment of all my Ip.gal debts, funeral expenses including my
grave marker and all expenses of my last illness, state, federal estate and inheritance
taxes and administration costs shall be paid as soon as may be conveniently done
following my decease leaving all specific bequests free of tax to the legatee.
SECOND: I give and bequeath my curio cabinet to Michael Gayman.
THIRD: I give and bequeath any auto;!lobile that I may own at the time of my
death to Ryan Gayman.
FOURTH:
I give and bequeath to Saint Judes Children's Hospital of Memphis
Tennessee the sum of $10,000.00.
FIFTH: The rest and residue of my estate, be it rec:.l, mixed or personal I give,
devise and bequeath to my children, Rosalyn /Viarie Kann, Harold Linn Gayman, Glenda
Kay Craig and Leslie Shoop Gayman, in equal shares, share and share alike, per stirpes.
SIXTH: I nominate and appoint Harold I jrm Gayman and Leslie Shoop Gayman
as executors of my estate to serve without bond of any ndture or kind. It is my desire
to treat all my children equally and I have only named two children9s~xecu.tofs~o..I:~ly
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for the ease of administration and not to in anyway exclude any child. :<..' > J:
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IN WITNESS WHEREOF, I, MARGARET M. GAYMAN, to this my Last Will and
Testament set my hand and official seal, this ~ day of April 2003.
~;~~~ ~f- ~~~~~ 6",,",'>1/ (SEAL)
Sworn to and subscribed, declared and
Published by Margaret M. Gayman, as
Her Last Will and Testament, and so
Done in the presence of we the
Witnesses, who sign at her request,
And in her presence, and in the presence
Of each other.
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COMMONWEALTH OF PENNSYLVANIA:
:SS
COUNTY OF CUMBERLAND
I, fvlargaret M. Gayman, whose name is signed to the foregoing instrument,
having been duly qualified according to law, do hereby acknowledge that I signed it
willingly; and that I signed it as my free and voluntary act for the purpose therein
expressed.
"V'p,\,~,-ct- r.-~ ' ll"--'-b'~ " ,,-,,,'
Margar' t M. Gayman .
Sworn to and acknowledged, before me,
By Margaret M. Gayman, the Testatrix,
This (1.'}~''c-:..L day of cl 2003.
~
~~
Notary Public
\ Notarial Seal
H Anthony Adams, NotaI'}' Public
Shippensburg Boro. c;umberland County
My Commission ExpIres May 15, 2006
Membei, pennsylvania ASsCClali,,'1 ot l'!ol;ries
COMMONWEALTH OF PENNSYLVANIA:
:SS
COUNTY OF CUMBERLAND
WE, Darlene M. Bigler and Sharon Coleman Adams, the witnesses whose names
are signed to the foregoing instrument, being duly qualified according to law, do depose
and say that we saw the Testatrix sign and execute the instrument as her Last Will and
Testament; that she signed willingly and that she executed it as her free and voluntary
act for the purposes therein expressed; that each of us in the hearing and sight of the
Testatrix signed the Will as witnesses, and that to the best of our knowledge and belief
the Testatrix was at the time at least eighteen (18) or more years of age and of sound
mind and under no constraint or undue influence.
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Sworn to and subscribed before me by,
Darlene M. Bigler an~r~ron COle~l't.~a arms,
The witnesses, this --=v:Y.:.- day of ~' 2003
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Notary Public
Notarial Se:l1 .
H. Anthony Adams. Notar;n~U~~~nty
Shippensbu~g .Boro. c;umbMer1 15 2006
My CommIssIon Expires ay ,
. ''''''''bl?f. Penns\lI\I?"i::l Msor:iation r~ 1\J0t;lries
A. Settlement Statement
U.S. De~rtment of Housing
and Urban Development
........
,r
OMB Approval No 2502-0265
B. Type 01 Loan
,. 0 FHA 2 0 FmHA 3. 0 Conv. Unins. 6 f"o N"",be,
4. 0 VA 5. 0 Conv Ins.
7 Loan Number
8_ Mortgage InsU(a~ Case Numbef
C. Note: This form is furnished 10 give you a statement of actual settlement cosls. Amounts paid to and by the seltlement agent are
shown. Items marked "(p.o.c.)" were paid outside closing; they are shown here for informational purposes and not
included ,n the lolals.
o Name: arid Address of Borrower E Name and A(JdreSl of SeU.r F, Name and Addross of l.eoder
Harold l. Gayman
Olivia J. Zinn
Shippensburg, PA
Estate of M. Marie Gayman
a/kla Margaret M. Gayman
a/k/a Margaret Marie Gayman
Shippensburg. PA
Orrstown Bank
Shippensburg, PA
Lot mock
J. Summary of Borrowet'. Transaction
100. Gross Amount Due From Borrower
101 Contract sales pnce
102 Personal property
103 Settlemenl charges 10 bonower (hoo 1400)
104
105
H Sel.t\emant Agent
Joel R. Zullinger, Esq.
PI8c8 Qf Selllemelll
77 East King Street
Shippensburg
PA 17257
I SetUement Date
7/28/2006
Oi$bursement Dale
7/2812006
G PlOp.my LocallOf1
1115 Newburg Hoad
Shippensburg, PA
K. Summary of S.II.r's Trans.ctlon
400. Gross Amount Du. To S.l....
160,000.00 401 Conlract sal.. price
402. Personal property
2,694.50 403
404
405.
160,000.00
,- --------
Adjustments for' items paid by s.eUer in advance
106 Cityltown taxes to
107 Coumy 1a.e. "7128/20060 12/31/2006
106. Asses.menls 7/281200fi, 6/30/2007
109 10
lW .
111 10
112 10
113, to
114 10
115 10
120. Gross AmDunt Due From Borrower
200. Amounts Paid By Or In Sehalf Of Borrower
201 Oeposit or earnest money
202 Pnocipal an-K>l.Jnt of new loan(S)
203. Exisbng loan(s) taken subject to
2Q4.
205.
200
207
206
209
406
114.51 407.
1,238.42 4lle
409
410.
AdJustm.nts lor it.ms paid by ..II.r In advance
CIty/town taxes to
Counly t.... 7/28/200fi, 12/31/2006
A.....ment. 7/281200fi, 6/3012007
10
10
114.51
1,238.42
411.
412
413
10
10
10
414 10
415 to
164,047.43420. Grosa"mountDu.ToS.ller
SOD. Raductlonaln Amount Due To S.lIer
0.00501. e.cessdeposi! (.eemltruction.)
35,000.00 502 Selll.ment charges 10 oelle<\line 1400)
503 e.isting Ioan(s) lak.n .ubleel to
504 P.yo" of first mortgage loan
505 Payo" or .econd mortgage loan
500
507.
508.
S09.
161,352.93
0.00
9.288.74
Adju$tments for items unpaid by Better
210 Cill/Itown ta.es 10
21 t. County taxes. to
212 A.$se$!.ments to
213. to
214 10
~5 .
216. to
~7 .
218 10
219 \0
"dJu.tm.nts lor Items unpaid by s.ne,
510 City/lown tax.. to
511 County taxes to
512. Assessments 10
513. to
514 to
515 10
5~ to
517 to
518 to
519
10
300. Cash At Settl.ment FromlTo Borrower
:301 Gross Amount due trom borrower (line 120)
302 less amount paid byJfor OOffowel' (line 220)
35,000.00 520. Total R.ductlon "mount Du. Soller
600. Cash At SeUlemont To/From Sener
164,047.43 601 Grossamount due \0 leller (line 420)
35,000.00) 602. less reduClions in amI. due seller (Iin. 520)
9,288.74
220. Totol Paid By/For Borrower
303. Ca.h
00 from
o To Borrower
129,047.43 603. Cash
IRho
o From Seller
161,352.93
9,288.74)
152,064.19
SUBSTITUTE FORM 1099 SELLER STATEMENT
The Information contained tn 8kJcks E. G. H. and I and on Iioe 401 (Of. line 403 and 404) is important tax information and is being furnished to the Internal Revenue
Service If you are required to tile a return, a negligence penatty 01 otl1er sanction wilt be imposed on you tf thIS item is required to be reported and the IRS determines
that it has not been repol1ed.lfthis feal estate 15 your principal residence, file Form 2119, Sale or Exchange of Principal Residence. for any gain, with YOUf income ta::.
return; for orher tlansacttOOs, complete the. ilPPliCab~ parts ot form 4797. Form 6232 and/or Schedule 0, FOf.m 1040). You are required to pt'ovide the Settlement Agenr
(named aboote) W\th YOuT correct taxpayer Kfent(ttcattOn number. If you do not provtde the Settlement Agent with your correct taxpayer identtficabon number. you may be
subject to ClVit O( criminal penalties. imposed by law. Under penallteS of perjury, t certify that the number shown on tnts statement is my correct taxpayer identifiCation number
(Seller'. Signalure)
L. Sottlement Chargo$
100. Total $alesJBrokc"s Commission based on price :5
D.vislon 01 Cornmlssl\11l lime 1'001 :lS follows
'to-
l01
702
',C,:} CommissIon p~ld II Settlemellt
704 Leqacy Auction
80(), Itellls Payable 'n Connec\i()n With loan
801 Lo"n 009"'allon' ee 35,000.00 %
802 Loan D..count 35,000.00 %
803 Apprat$al ree 10
804 CredIt Report to
805 lender's Inspechcn r.?e
aCD Mortgage Insuran.:e I\ppllcabon Fee '0
607. A'S$llrnphon Fee
808 Underwriting fee
809 Document preparation fee
810 Application fHe
811
812
8\3
900. Items Required 8y Lender To Be Paid In Advance
SO 1 Interest from to @S
902 Mongage insurant e Premium tor
903 Hazard Insurance Premium tor
904
~a5
1000. Reserves Deposited With lender
1001 Hazard InStlranCf;' 1
1002 Mortg,otge insurar,ce 1
1003 Clly property I... S 1
1004 County prape/ly UX!~s 1
to05 Allnu~1 assessnV'f,l5 1
1006 1
1007 1
1008 AQqregate Accou'\ttnq Adlus.tntel\t
11QO. 1i\lo Charge.
1101 Semement or clOSing Ice
1102 Abstract or tItle sealeh
1103 TItle eX3min.;:t\ion
1104 T,tle Insurance bllldel
11 05 Docu~nt prepacatton
"00 t-k>lBry fees,
1107 Attorney's tees
(Includes above ilf:ms fllllnOOfS
1108 Ti\1e InSU(3m;,e
(lndudcs above Ilems nUl1lbers
1109 Lender's covcmqn
1110 Owl\e('s.co~efage
Ill'
1112
1'13
1200, Government Recording and Transtcr Charges
1201 Roce'don9 fees Deed $ 39.00 . """19890 $
1202 Citylcounty t../slamps Deed $ 1,600.00 ; M0r19age
1203, State t8x/S!:Jmps' Deed $ ; Mortgage
1204 Vivian Coy, 2006-07 school at discount
1307
1308
1400. Total Settlement Chargas (onter on llne~ 103. Section J and 502. Section K)
CER1IFICA TION
~~.~~~ ~~ci::::;l ~~~)~dll~;:~~:~~~~,~f~:\~=~t~:~~, t~~~ ::'~I~ed'1 ~~~d~: ~n8~.~Ii~~t~~~~tUSt:::'n:=n~urate statement of all rece\p\s and disbursements
';~~~~~i~~:ta~ <,I/O.
(i~~f;'} -ln~/'! ;'
1?{)~
1300, Addniona. Settlemellt Charges
,30t Swve)'
1302 Pes\( IOSp('CtlQn to
13Q3 CJFMA, final utility
130,1 PennElec, final utility - POC
1305
130')
. . l i
Estate of N. Marie Gayman
a/k/a Margaret M. Gayman
160,000.00 If!l
Paid rrom
BorrOW'er's
Funds At
Se\1lemen\
Paid From
Seller's
Funds At
SelUement
to
to
6,345,74
E)(dude last day in cales -line 901
I day
months 10
years to
years 10
monlhS@$
months@S
months@S
monthS@$
fOOn1hS\...'q;$
rnonths@S
munUls@$
per montl'l
per month
per month
pel mon1h
per month
per month
per month
\0
\0
10 Joel R. Zullinger
800.00
to
\0 Joel R. Zullinger
to Carin L. Waller/cash
10 Joel R. ZuUinger
100,00
5.00
100.00
5.00
to
50.50 ,Releases $
89.50
1,600.00
0.00
1,600.00
1,314.48
10
23.52
2,694.50
9,288.74
Selle,
Borrower
Seller
Borrower
To the t)@SlofrflV knowle<Jge the HU[).' Seltlement Statement Wh\l:h' have prepa.oo is a true and accurare account of the funds whidt were roceived and hav~ neen Qf Will
0(' od by the unders.gned~i)S art of the selllemcflt e4 IhlS lransaetion
~ ~. ..~.t..~ .~ setllemenlAgent 7 - z. f -4C1 Dafe
R Zullinger, Esq t7
W HNIr~G. It IS a cmnc 10 knO\: l~JIy Inakfl lalsp. st~tem(tflts to the Unlled S\a\es 0fI1h\s 01 any other sl/nllsr form, Penallies upon conviction can indude a fine and
lmpr1~(\flll1~nf r (), dnli.l.I~ '\f:e J rfle 16 U S Code $['(:1101\ 1001 ;l(\(1 Sochon 1010
tJ S GOVFRHMfHf PRtNfWGOFFlCF: ttn..~ IU
~
cltlgroupJ
SMITH BARNEY
446 Stouffer Avenue
Chambersburg. PA 17201
Tel 717-264-5901
Toll Free 800-842-7076
Fax 717-264-6483
August 28, 2006
Zullinger-Davis Attorneys at Law
ATTN: Carol
14 North Main Street
Suite 200
Chambersburg, PA 17201
"
RE: Estate of Margaret Gayman
Dear Carol:
Attached please find the date of death values for the individual account of
Margaret Gayman. This account was established 4/7/1988.
If you should need any further information, please feel free to contact me at
717-264-5901.
Sincerely,
~~.~
Stacey C. Schuler
Sr. Sales Assistant for
Stephen A. Rost
Citigroup Global Markets Inc.
THE INFORMATION SET FORTH WAS OBTAINED FROM SOURCES WHICH WE BELIEVE RELIABLE BUT WE DO NOT GUARANTEE ITS ACCURACY OR COMPLETENESS.
NEITHER THE INFORMATION NOR ANY OPINION EXPRESSED CONSTITUTES A SOLICITATION BY US OF THE PURCHASE OR SALE OF ANY SECURITIES.
~
cltlgroupJ
SMITH BARNEY
446 Stouffer Avenue
Chambersburg. PA 17201
Tel 717-264-5901
Toll Free 800-842-7076
Fax 717-264-6483
639-03446-19-308
Prices as of 04/28/2006
Shares Security Cusip No. High Low Close
42.47 CASH
1792.55 Bank Deposit Program 123992711000 1.00 1.00 1.00
2.96 Accrued Interest
3049.8696 Municipal High Income Fd. Inc. 62621410 7.39 7.32 7.34
1247.122 Capital W orId Growth and 14054330 40.08 40.08 40.08
Income Fund Class C
4166.593 Legg Mason Partners Capital & 52469F60 17.73 17.73 17.73
Income Fund Class A
25,000 Lehman Brothers Bank, FSB 52519H4R5 100.00
10,000 Rabobank Natn'l Assn. Calif. 74977NCNl 100.00
126.71 Accrued Interest - Lehman
Brothers Bank
35.61 Accrued Interest - Rabobank
The information contained herein was prepared by the undersigned for informational purposes only and does not
represent an official statement of the account at Smith Barney. Please refer to the monthly statements for a
complete record of transactions, holdings, and balances.
Citigroup Global Markets Inc.
THE INFORMATION SET FORTH WAS OBTAINED FROM SOURCES WHICH WE BELIEVE RELIABLE BUT WE DO NOT GUARANTEE ITS ACCURACY OR COMPLETENESS.
NEITHER THE INFORMATION NOR ANY OPINION EXPRESSED CONSTITUTES A SOLICITATION BY US OF THE PURCHASE OR SALE OF ANY SECURITiES.
..
cltlgroupJ
SMITH BARNEY
446 Stouffer Avenue
Chambetsbutg, PA 17201
Tel 717-264-5901
Toll Free 800-842-7076
Fax 717-264-6483
639-03446-19-308
Prices as of 05/01/2006
Shares Security Cusip No. High Low Close
42.47 CASH
1792.55 Bank Deposit Program 123992711000 1.00 1.00 1.00
2.96 Accrued Interest
3049.8696 Municipal High Income Fd. Inc. 62621410 7.41 7.35 7.35
1247.122 Capital World Growth and 14054330 40.08 40.08 40.08
Income Fund Class C
4166.593 Legg Mason Partners Capital & 52469F60 17.69 17.69 17.69
Income Fund Class A
25,000 Lehman Brothers Bank, FSB 52519H4R5 100.00
10,000 Rabobank Natn'l Assn. Calif. 74977NCNl 100.00
126.71 Accrued Interest - Lehman
Brothers Bank
35.61 Accrued Interest - Rabobank
The information contained herein was prepared by the undersigned for informational purposes only and does not
represent an official statement of the account at Smith Barney. Please refer to the monthly statements for a
complete record of transactions, holdings, and balances.
Citigroup Global Markets Inc.
THE INFORMATION SET FORTH WAS OBTAINED FROM SOURCES WHICH WE BELIEVE RELIABLE BUT WE 00 NOT GUARANTEE ITS ACCURACY OR COMPLETENESS.
NEITHER THE INFORMATION NOR ANY OPINION EXPRESSED CONSTITUTES A SOLICITATION BY US OF THE PURCHASE OR SALE OF ANY SECURITIES.
rI M&fBank
499 Mitchell Road, Millsboro, DE 19966 Mail Code DE-MB-12
Phone (888) 502-4349
Fax (302) 934-2955
May 19, 2006
Law Offices
Zullinger - Davis
14 North Main Street
Suite 200
Chambersburg, Pennsylvania 17201
Re: Estate of" A! Marie Gavman
Social Securitv: 192-14-5089
Date of Death: Avril 29. 2006
Dear Sir or Madam:
Per your inquiry dated May 15, 2006, please be advised that at the time of death, the above-named decedent had on deposit
with this bank the following:
I.
Type of Account
Checking Account
Account Number
67354629
Ownership (Names of)
M Marie Gayman *
Opening Date
/ //28/85 Closed 05/17/06
Balance on Date of Death
$/2,830.85
Accrued Interest
$
0.72
Total
$12,831.57
Please be advised, there was no safe deposit box found for the above decedent.
* For further account information, regarding ownership, closures and/or reimbursement of funds, etc., please call
the King Street Office # 717-532-4132.
Sincerely,
-77~
Nancy Clagett
Records Management
~.'
Kell~y Blue Book - Private Party Pricing Report - Mercury, Sable
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[j@
ill MONUMENTAL LIFE
INSURAMCE tOMPANY
Monumental Life Insurance Company
Home Office:
Baltimore, Maryland
Administrative Office:
4333 Edgewood Road NE
PO Box 3183
Cedar Rapids, Iowa 52406-3183
June 3, 2006
Estate of M Marie Gayman
c/o Joel Zullinger Atty
14 N Main St Ste 200
Charnbersburg PA 17201
RE: Annuity NUmber(s} 010SP730424
Dear Beneficiaries:
We have received notification, M Marie Gayman, annuitant of the above
listed non-qualified tax deferred annuity is deceased. Our office
wishes to extend sincere condolences for your loss.
The following is the current information on this annuity:
Annuity Policy Date:
Full Value as of 06/05/2006:
Taxable Portion:
Full Value as of 04/29/2006:
M Marie Gayman
M Marie Gayman
Harold L Gayman 25%
Leslie S Gayman 25%
Rosalyn M Kann 25%
Glenda K Craig 25%
January 12, 2000
$67,594.86
$17,594.86
$67,403.54
Annuitant:
Owner:
Primary Beneficiary(ies) :
The attached document outlines the options available to the primary
beneficiary (ies) listed above.
The full value as of the date of death is for tax purposes only and is
not a guaranteed death benefit amount.
Operations performed on an automatic basis when applicable have been
terminated, such as, Systematic Payouts or Automatic Billing.
Member of the _EGON. Group
--
.~
The attached document contains general tax information based on
Monumental Life Insurance Company's interpretation and should not be
relied upon for your personal tax planning. If you have questions
concerning the direct tax consequences when selecting an option, you
may wish to consult a tax advisor.
Any additional questions regarding this annuity can be directed to the
Annuity Service Center at 1-800-553-5957. A Monumental Life Insurance
Company representative will gladly assist you with any questions you
may have regarding this annuity and help you meet your financial
goals.
Sincerely,
d#w<<~~.
Ansara C. Kula
Monumental Life
Claims
Insurance Company
Enclosure(s) :
Annuity Claimants Statement
Death Option Packet
Postage Paid Return Envelope
June 3, 2006
Law Offices
Zullinger - Davis
Attn: Joel R. Zullinger
20 E. Burd St., Suite 6
Shippenburg, P A 17257
RE:
Policy Number:
Deceased:
AN202303
M. Marie Gayman
Dear Mr. Zullinger:
1m)
AIG Annuity Insurance Company
P.O. Box 871
Amarillo, Texas 79105-0871
800.424.4990
Thank. you for your recent inquiry regarding the referenced annuity contract. It is our pleasure to be of
service to you. We would like to take this opportunity to respond to your letter dated May 22, 2006.
Type of Annuity Contract:
Date of Issue:
Contract Owner's Name(s):
Original Investment:
Cash Value as of Date of Death on April 29, 2006:
Beneficiary( ies):
Non Qualified Tax Deferred Annuity
December 3, 2001
M. Marie Gayman
$30,000.00
$35,681.65
Glenda Craig, Harold L. Gayman, Leslie S. Gayman
and Rosalyn Kann
If you have any questions please contact our customer service representatives, at 1-800-424-4990. We
appreciate this opportunity to serve you.
Sincerely,. ('"
B~~~~/
Claims Examiner 6
AIG Annuity Insurance Company
Member of American International Group, Inc.
LAW OFFICES OF
ZULLINGER - DAVIS
PROFESSIONAL CORPORATION
JOEL R. ZULLINGER
14 North Main Street
Suite 200
Chambersburg, P A 17201
717-264-6029
Fax: 717-264-1884
zulnl!flaw@earthlink.net
HAMILTON C. DAVIS
20 East Burd Street, Suite 6
P.O. Box 40
Shippensburg, P A 17257
717-532-5713
Fax: 717-530-5222
hamiltondavislaw@comcast.net
Dale F. Shughart, Jr.
of counsel
September 26, 2006
Register of Wills
Cumberland County Courthouse
Carlisle, P A 17013
Dear Register:
f')
=
c:::>
<:r'
(/)
rrl
-0
N
-.J
RE: Estate of Margaret Marie Gayman
a/k/ a Margaret M. Gayman
File No. 21-06-0400
(")
S;;o
- - - --n
-J ~-',"2
_ )'~) -0
In connection with the above estate, enclosed for filing in your office aretlj~OUowitif
documents: -o:=:j 7:
j'=- N
ex>
· Original and one copy of the PA Inheritance Tax Return;
. Original of the Inventory;
· Check payable to Register of Wills, Agent in the amount of $1,056.79 for the
balance of tax due; and
· Check payable to Register of Wills in the amount of $30.00 for filing fee.
If you have any questions, please contact my Chambersburg office above. Thank you.
Encls.
Very truly yours, .
. ~~\c.v
J el R. ZullingeU ~ U
-
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